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The future of pharmacological therapy for risk factor reduction. Hypertension
1Department of Medicine, University of Göteborg, Ostra Hospital, Sweden.
Insights
Treating high blood pressure lowers risks, but coronary heart disease risk remains high. Improving treatment by reaching normal blood pressure and using lipid-friendly medications can reduce cardiovascular disease risk.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Antihypertensive treatment reduces hypertension-related mortality and morbidity.
- Current treatments yield suboptimal cardiovascular outcomes, especially for coronary heart disease.
- Elevated serum lipoprotein concentrations from some antihypertensive agents may counteract therapeutic benefits.
Purpose of the Study:
- To identify strategies for improving antihypertensive treatment outcomes.
- To reduce the residual cardiovascular risk in treated hypertensive patients.
- To specifically address the limited impact of current treatments on coronary heart disease risk.
Main Methods:
- Review of existing antihypertensive treatment guidelines and outcomes.
- Analysis of the effects of commonly used antihypertensive agents on serum lipoproteins.
- Exploration of potential adjunctive therapies for lipid management in hypertensive patients.
Main Results:
- Strictly normotensive blood pressure levels are desirable for optimal outcomes.
- Angiotensin-converting enzyme (ACE) inhibitors are suggested as antihypertensive agents with neutral effects on lipoproteins.
- Combined antihypertensive and lipid-lowering therapies may enhance cardiovascular risk reduction.
Conclusions:
- Optimizing antihypertensive therapy requires achieving normotensive blood pressure levels.
- Utilizing antihypertensive agents that do not adversely affect serum lipoproteins is crucial.
- Integrating lipid-lowering strategies in selected hypertensive patients can improve coronary heart disease risk reduction.
Abstract:
Treatment of elevated arterial pressure has been shown to reduce hypertension-induced mortality and morbidity in severe as well as in milder forms of hypertension, but results are suboptimal, and treated hypertensive patients still have significantly higher cardiovascular morbidity and mortality than comparable normotensive subjects. In particular, the risk of coronary heart disease has been little affected by antihypertensive treatment. There may be several explanations for these less than ideal results of antihypertensive treatment; for example, that blood pressure has not been brought down to strictly normotensive levels or that several of the commonly used antihypertensive agents increase serum lipoprotein concentrations, which to a certain extent may offset the intended therapeutic effect. To improve results of antihypertensive treatment it appears desirable (1) to lower blood pressure to strictly normotensive levels, (2) to use antihypertensive agents, e.g. ACE inhibitors, which do not negatively affect serum lipoproteins, (3) to supplement antihypertensive therapy with active lipid-lowering therapies in selected patients. Such means should have a positive effect on reducing the risk of coronary heart disease.